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Cherepacha N, St George-Hyslop F, Chugani B, Alabdeen Y, Sanchez-Espino LF, Mahood Q, Sibbald C, Verstegen RHJ. Management and Long-Term Outcomes of Drug Reaction with Eosinophilia and Systemic Symptoms (DReSS) in Children: A Scoping Review. Am J Clin Dermatol 2024; 25:609-621. [PMID: 38755503 DOI: 10.1007/s40257-024-00867-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2024] [Indexed: 05/18/2024]
Abstract
Drug reaction with eosinophilia and systemic symptoms (DReSS) is known to cause mortality and long-term sequelae in the pediatric population, however there are no established clinical practice guidelines for the management of pediatric DReSS. We conducted a scoping review, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, to summarize the currently available data on treatment, mortality, and long-term sequelae of DReSS in children (aged 0-18 years). Data from 644 individuals revealed that various treatment strategies are being used in the management of pediatric DReSS, and strategies were often used in combination. The diversity in treatment approaches cannot be solely attributed to age or disease severity and reflects the lack of evidence-based management guidelines for DReSS. Children are also at risk of developing autoimmune sequelae following DReSS, most commonly thyroid disease and type 1 diabetes mellitus. We found that the eventual development of autoimmune disease was more often associated with DReSS caused by antibiotics, especially minocycline and sulfamethoxazole, in comparison with individuals who did not develop sequelae. In this study, we identify strengths and weaknesses in the currently available literature and highlight that future prospective studies with structured and long-term follow-up of children with DReSS are needed to better understand potential risk factors for mortality and development of sequelae after DReSS.
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Affiliation(s)
- Nicole Cherepacha
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Clinical Pharmacology and Toxicology, Department of Paediatrics, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
| | - Frances St George-Hyslop
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Clinical Pharmacology and Toxicology, Department of Paediatrics, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
| | - Bindiya Chugani
- Division of Clinical Pharmacology and Toxicology, Department of Paediatrics, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
| | - Yousef Alabdeen
- Division of Immunology and Allergy, Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Luis F Sanchez-Espino
- Division of Dermatology, Department of Paediatrics, Stollery Children's Hospital, Edmonton, AB, Canada
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Quenby Mahood
- Hospital Library, The Hospital for Sick Children, Toronto, ON, Canada
| | - Cathryn Sibbald
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
- Division of Dermatology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Ruud H J Verstegen
- Division of Clinical Pharmacology and Toxicology, Department of Paediatrics, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada.
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada.
- Division of Rheumatology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada.
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Kim GY, Anderson KR, Davis DM, Hand JL, Tollefson MM. Drug reaction with eosinophilia and systemic symptoms (DRESS) in the pediatric population: A systematic review of the literature. J Am Acad Dermatol 2020; 83:1323-1330. [DOI: 10.1016/j.jaad.2020.03.081] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 03/11/2020] [Accepted: 03/25/2020] [Indexed: 12/17/2022]
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Drug Reaction with Eosinophilia and Systemic Symptoms (DReSS): How Far Have We Come? Am J Clin Dermatol 2019; 20:217-236. [PMID: 30652265 DOI: 10.1007/s40257-018-00416-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Drug reaction with eosinophilia and systemic symptoms (DReSS), also known as drug-induced hypersensitivity syndrome (DiHS), is an uncommon severe adverse reaction to medications. It is important to recognize it as it is potentially fatal and can cause significant morbidity. From the first reports of drug reactions related to certain anticonvulsants characterized by fever, liver enzyme elevation, and skin changes, our continuously growing understanding of this entity has allowed us to describe its physiopathology and clinical features even further. The relationship of genetic factors, viral activation, and specific drug exposure is now known to play a role in this disease. There is still not a widely accepted marker for DReSS/DiHS, but the spectrum of clinical and laboratory features has now been better outlined. The mainstay of treatment is the use of systemic corticosteroids, but other options such as intravenous immunoglobulin, cyclosporine, mycophenolate mofetil, rituximab, and cyclophosphamide have been described. We present a comprehensive review of the literature on DReSS/DiHS, focusing on its history, etiopathogenesis, diagnosis, therapeutic approach, and outcome.
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Affiliation(s)
- Rameshwar M Gutte
- Department of Dermatology and Neurology, Dr. L. H. Hiranandani Hospital, Powai, Mumbai, India
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Abstract
A 16-year-old male patient, with a history of essential hypertension enrolled in an experimental drug protocol using allopurinol, presented to our emergency department with a 10-day history of fever. Initial laboratory evaluation revealed leukocytosis, eosinophilia, and transaminitis. After extensive work-up and exclusion of infectious and oncologic etiologies, the diagnosis of allopurinol-induced drug reaction and eosinophilia with systemic symptoms syndrome was carried out. The patient responded to administration of IV methylprednisolone, with complete resolution of symptoms and improvement of laboratory abnormalities. This case represents the first report of allopurinol-induced drug reaction and eosinophilia with systemic symptoms syndrome in a pediatric patient.
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Affiliation(s)
- Ashvin K Dewan
- Department of Pediatrics, Baylor College of Medicine, Division of Emergency Medicine, Texas Children's Hospital, Houston, Texas 77030, USA
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Albrecht J, Fine LA, Piette W. Drug-Associated Lymphoma and Pseudolymphoma: Recognition and Management. Dermatol Clin 2007; 25:233-44, vii. [PMID: 17430760 DOI: 10.1016/j.det.2007.01.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This article discusses ways to recognize and manage lymphomas and pseudolymphomas associated with drug exposure. Over the last 30 years, the classification of pseudolymphomas and lymphomas has undergone significant change, especially following the application of sophisticated immunostaining and gene rearrangement analysis. The term cutaneous pseudolymphomas (CPL) is a nonspecific term for a heterogeneous group of benign reactive T- or B-cell lymphoproliferative processes that simulate cutaneous lymphomas clinically or histologically. While pseudolymphomas are relatively rare diseases, their clinical and histological heterogeneity has led to multiple systems of categorization based on immunological factors, causative agents, presentation, and clinical course.
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Affiliation(s)
- Joerg Albrecht
- Department of Medicine, Division of Dermatology, John Stroger Jr. Hospital of Cook County, Administration Bldg., 1900 W Polk Street, Chicago, IL 60612, USA
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Verrotti A, Trotta D, Salladini C, Chiarelli F. Anticonvulsant hypersensitivity syndrome in children: incidence, prevention and management. CNS Drugs 2002; 16:197-205. [PMID: 11888340 DOI: 10.2165/00023210-200216030-00006] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Anticonvulsant hypersensitivity syndrome (AHS) is a rare, but potentially fatal, adverse reaction that occurs in patients, including children, who are treated with anticonvulsants. During metabolism of the anticonvulsant, toxic arene-oxide compounds are produced. AHS is associated with both cutaneous and systemic symptoms and is associated with multiorgan involvement. Liver damage, in particular, seems to be associated with fatal outcomes. The pathophysiology of AHS is still uncertain but it may be linked to a genetically determined inability to detoxify reactive drug metabolites. The prompt recognition of the first clinical signs of AHS, and the rapid withdrawal of the anticonvulsant, often avoids the progression of symptoms. Pharmacological treatment is essentially based on systemic corticosteroids in association with enteral nutrition, intravenous fluid augmentation, pain relief and ocular care. Intravenous immunoglobulins may also have a possible therapeutic role in some cases. Diagnostic tests, such as patch tests or in vitro assays, for AHS could help to identify patients at risk of developing the syndrome and could represent a first step of primary prevention when applied to relatives of patients.
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Affiliation(s)
- Alberto Verrotti
- Department of Pediatrics-Policlinico Colle Dell'Ara, University G. D'Annunzio, Chieti, Italy
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De Vriese AS, Philippe J, Van Renterghem DM, De Cuyper CA, Hindryckx PH, Matthys EG, Louagie A. Carbamazepine hypersensitivity syndrome: report of 4 cases and review of the literature. Medicine (Baltimore) 1995; 74:144-51. [PMID: 7760721 DOI: 10.1097/00005792-199505000-00004] [Citation(s) in RCA: 77] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
We report 4 patients who developed a severe systemic hypersensitivity reaction when taking carbamazepine, To prove hypersensitivity to carbamazepine, we performed patch tests and in vitro lymphocyte transformation tests. Patch tests were uniformly and strongly positive in patients and negative in controls. Lymphocyte transformation tests were positive in 3 of 4 patients. We reviewed the literature on reports of carbamazepine-induced pseudolymphoma and other severe systemic hypersensitivity reactions. Considering the many common clinical, biochemical, and pathologic characteristics, we propose to group these reactions under the term "carbamazepine hypersensitivity syndrome." The syndrome is characterized by the development of fever, rash, and lymphadenopathy between 1 week and 3 months after the introduction of carbamazepine. A variety of other target organs may be involved, including the liver, kidneys, and lungs. The carbamazepine hypersensitivity syndrome is a clinical diagnosis. Patch tests and lymphocyte transformation tests are valuable tools to confirm the diagnosis, but are reliable only after all signs subside. Similar syndromes have been described with the other aromatic anticonvulsants (phenytoin, the other hydantoins, and phenobarbital), and there is evidence of a cross-reaction between carbamazepine and phenytoin. It is unknown whether the carbamazepine hypersensitivity syndrome should be considered a premalignant state, with an increased risk for the development of malignant lymphoma.
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Affiliation(s)
- A S De Vriese
- Department of Internal Medicine, AZ St. Jan, Bruges, Belgium
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Rispal P, Lasseur C, Labouyrie E, Doutre MS, Pellegrin JL, Bernard P, Merlio JP, De Mascarel A, Leng B. [Pseudolymphoma induced by carbamazepine. Apropos of 2 cases]. Rev Med Interne 1995; 16:214-8. [PMID: 7740234 DOI: 10.1016/0248-8663(96)80695-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We present two pseudolymphoma occurring 8 days and 1 month after carbamazepine introduction. Both patients present fever, rash, generalized lymphadenopathy and hepatosplenomegaly in the second case. Hematologic abnormalities included anemia, eosinophilia, hepatic cytolysis. Histologic evaluation of a lymph node biopsy specimen demonstrated near-total effacement of the nodal architecture mimicking a lymphoma. Gene rearrangement studies proved the benign nature of the proliferation. Carbamazepine-induced lymphoproliferative disorders are relatively rare with only 38 observations published. The pathogenesis is uncertain. Immune dysregulation is probable. Morphologic and immunophenotypic data must be completed by gene rearrangement studies. Corticoid therapy is useless. The evolution is favorable after the cessation of carbamazepine.
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Affiliation(s)
- P Rispal
- Clinique de médecine interne et de maladies infectieuses, hôpital du Haut-Levêque, Pessac, France
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Parha S, Garoufi A, Yiallouros P, Theodoridis C, Karpathios T. Carbamazepine hypersensitivity and rickettsiosis mimicking Kawasaki disease. Eur J Pediatr 1993; 152:1040-1. [PMID: 8131807 DOI: 10.1007/bf01957233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We report on two patients whose clinical presentation resembled that of Kawasaki disease. The first patient was a boy with epilepsy, whose symptoms first appeared following treatment with carbamazepine. The second boy had Mediterranean Spotted Fever. The significance of medical history in avoiding overdiagnosis of Kawasaki disease is emphasized.
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Affiliation(s)
- S Parha
- Second Department of Paediatrics, A. P. Kyriakou Children's Hospital, GR-Athens, Greece
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Gebauer K, Holgate C, Navaratnam A. Toxic pustuloderma. A drug induced pustulating glandular fever-like syndrome. Australas J Dermatol 1990; 31:89-93. [PMID: 2151365 DOI: 10.1111/j.1440-0960.1990.tb00659.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A striking cutaneous eruption developed in a fifty-eight year old woman with bipolar affective disorder three weeks after starting carbamazepine therapy. She had an infectious mononucleosis-like systemic illness associated with myriads of cutaneous micropustules, erythroderma and a high eosinophil count. A similar eruption due to carbamazepine has been reported only twice before, but isolated cases ascribed to other medications exist. We believe that this reaction is a specific class of drug eruption best named Toxic Pustuloderma.
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Affiliation(s)
- K Gebauer
- Dermatology Dept., Royal Perth Hospital, WA
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